Sham Manipulation Research Articles

Immediate Effects of Lumbar Spine Manipulation on the Resting and Contraction Thickness of Transversus Abdominis in Asymptomatic Individuals

Randomized, blinded, controlled crossover trial. To determine if thrust joint manipulation (TJM) to the lumbar spine would result in changes to the resting and contraction thickness of transversus abdominis (TrA) in healthy individuals. Recent studies have demonstrated an immediate decrease in resting thickness and an increase in contraction thickness in TrA following lumbar TJM in patients with low back pain (LBP) who met a clinical prediction rule (CPR) for spinal manipulation. This observed phenomenon has not been investigated in healthy individuals. Thirty-five healthy participants were randomly assigned to receive a TJM or sham manipulation treatment. All participants received instruction on how to produce an isolated concentric contraction of the TrA that involved visual ultrasound imaging biofeedback. Data were analyzed using ultrasound imaging to measure changes in thickness of the TrA at rest and during contraction, following the administration of each treatment. There were no interactions observed between treatment and time for TrA muscle thickness at rest (P = .351) and during the contracted state (P = .761). Our results indicate that TJM to the lumbar spine does not appear to affect the resting or contraction thickness of TrA in healthy individuals. These findings are in contrast to previous research in which patients with LBP who met a CPR demonstrated an immediate decrease in resting thickness and an increase in contraction thickness in TrA following lumbar TJM.

Conservative Management of Lumbar Disc Herniation With Associated Radiculopathy

A systematic review of randomized controlled trials. To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR). Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear. We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment. Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events). Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy.

Love bites: male fang use during coercive mating in wolf spiders

Evolutionary conflicts of interest between the sexes are common, as mating tactics and strategies that increase fitness benefits for one sex may incur costs for the other. As a consequence, antagonistic coevolution between the sexes often results in a complex arms race between male persistence and female resistance. Coercive mating (e.g., forced copulation) likely benefits males by increasing the probability of mating; however, costs to females may be high, including injury or even death. Here, we report on a study of the use of fangs by males of the wolf spider Schizocosa ocreata (Hentz) during forcible mating with resistant females, which results in hemolymph loss and scar tissue formation in females. Microscopic inspection revealed that fang wounds (evidenced by scar tissue) were absent on unmated (virgin) females but were found on mated females and were significantly more frequent in coercively mated females. Experimental fang immobilization studies found no difference in copulation success between experimental (fangs immobilized) and control (sham manipulation) males. However, males that had use of their fangs had significantly longer copulation duration. These findings represent a previously unknown male mating tactic in spiders and an unrecognized potential cost of mating for female spiders.

Vertebral manipulation in chronic low back pain: a prospective randomised study of 85 cases

Objective: To study the efficacy of manipulation in the management of chronic low back pain. Patients and methods: An open prospective, controlled study of manipulation for patients with low back pain of over 6 months duration. Eighty-five patients were randomised to receive either true manipulations or sham manipulations, weekly for 4 weeks followed by independent assessment, and follow-up at 2 months. Results: In the true manipulation group, visual analogue score (VAS) for pain reduced significantly (P < 0.0001), as did the disability score (P < 0.001) by 1 month whereas no improvement was seen in the sham manipulation group: clinical examination features of dysfunction were also significantly improved in the manipulation group by 2 months. Conclusions: This study suggests that vertebral manipulation is a useful and effective treatment in the short term for chronic low back pain.

Rapid assimilation of yolk enhances growth and development of lizard embryos from a cold environment

Selection for rapid growth and development in cold environments results in a geographic pattern known as countergradient variation. The eastern fence lizard, Sceloporus undulatus, exhibits countergradient variation in embryonic growth and development along latitudinal clines. To identify the proximate causes of countergradient variation, we compared the energy budgets of embryos from a cold environment (Virginia) and a warm environment (South Carolina) during development at a realistic thermal cycle. The difference in mean egg size between populations was controlled by removing yolk from large eggs and performing a sham manipulation on other eggs. Respiration was measured every 4 days throughout 48 days of incubation. After this period, eggs were dissected and the energy contents of embryos and yolk were determined by calorimetry. As expected from previous experiments, embryos from Virginia reached a more advanced stage of development and deposited more energy within tissues than embryos from South Carolina. The greater absorption of yolk by embryos from Virginia was associated with a higher rate of respiration. Assimilation of yolk by rapidly growing embryos could reduce growth or survival after hatching. Such costs might explain the maintenance of countergradient variation in S. undulatus.

The role of chiropractic manipulation in promoting an individual's perception of psychological well being

Summary Background A paucity of chiropractic research focuses on the relationship between chiropractic treatment and psychological mood. It is, however, becoming increasingly important to evaluate psychological change resulting from chiropractic care. Such research is required both to protect the profession from criticism that its effectiveness resides in a placebo effect and also to confer validity to findings from studies that investigate the extension of chiropractic treatment to conditions known to be affected by psychological variables. Objective This research is intended as a preliminary study aimed at investigating, firstly, whether participation in chiropractic treatment, either sham or active, is able to alter dimensions of psychological well being and, secondly, if an alteration is seen to establish whether this can be attributed to manipulation. Research method This double-blind study was conducted on twenty asymptomatic subjects who were randomly allocated either to a group receiving active manipulation or to one receiving sham manipulation for a total of four interventions set over a 1-month period. Various markers of psychological well being were measured through the use of questionnaires (the perceived stress scale (PSS), the profile of mood states (POMS) questionnaire and the Spielberger state trait anxiety inventory (STAI)) given out before and after each intervention. Data were analysed per intervention for intra-group and inter-group changes as well as for intra-group changes over the time period of multiple interventions. Results Few statistically significant results were seen. These were clustered around the first intervention. Results showed that active manipulation, in contrast to sham, had a stronger and broader effect on promoting emotional well being. Sham manipulation also caused significant change but on fewer markers of psychological mood. No effect was as strong as to cause significant inter-group differences. Conclusion While active manipulation was seen to exert a stronger effect than sham manipulation on markers of psychological well being, the mechanism by which this effect is generated remains unknown. The changes seen are in part likely to be attributable to aspects relating to the clinical encounter; however, these changes are minimal and fail to exert any influence over time. This suggests that chiropractic care when effective is effective because it offers effective treatment and not an effective placebo via changes in psychological well being.

Chiropractic manipulation in Adolescent Idiopathic Scoliosis: a pilot study

BackgroundAdolescent idiopathic scoliosis (AIS) remains the most common deforming orthopedic condition in children. Increasingly, both adults and children are seeking complementary and alternative therapy, including chiropractic treatment, for a wide variety of health concerns. The scientific evidence supporting the use chiropractic intervention is inadequate. The purpose of this study was to conduct a pilot study and explore issues of safety, patient recruitment and compliance, treatment standardization, sham treatment refinement, inter-professional cooperation, quality assurance, and outcome measure selection.MethodsSix patients participated in this 6-month study, 5 of whom were female. One female was braced. The mean age of these patients was 14 years, and the mean Cobb angle was 22.2 degrees. The study design was a randomized controlled clinical trial with two independent and blinded observers. Three patients were treated by standard medical care (observation or brace treatment), two were treated with standard medical care plus chiropractic manipulation, and one was treated with standard medical care plus sham manipulation. The primary outcome measure was Cobb, and the psychosocial measure was Scoliosis Quality of Life Index.ResultsOrthopedic surgeons and chiropractors were easily recruited and worked cooperatively throughout the trial. Patient recruitment and compliance was good. Chiropractic treatments were safely employed, and research protocols were successful.ConclusionOverall, our pilot study showed the viability for a larger randomized trial. This pilot confirms the strength of existing protocols with amendments for use in a full randomized controlled trial.Trial registrationThis trial has been assigned an international standard randomized controlled trial number by Current Controlled Trials, Ltd. . The number is ISRCTN41221647.

Spinal manipulation for dysmenorrhoea

Background Dysmenorrhoea (occurrence of painful menstrual cramps of uterine origin) is a common gynaecological condition. The character of pain from musculoskeletal dysfunction can be very similar to gynaecological pain by presenting cyclicly and being altered by hormonal changes associated with menstruation. Medical treatment for dysmenorrhoea usually comprises anti-inflammatory drugs, oral contraceptives, or surgical intervention. Spinal manipulation is a non-medical intervention. It has been suggested that manipulation of the vertebrae may increase spinal mobility thus improving pelvic blood supply and facilitating pain relief. Objectives To determine the safety and efficacy of spinal manipulative interventions for the treatment of dysmenorrhoea when compared to each other, placebo, no treatment, or other medical treatment. Search methods In this update we searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (May 2009), CENTRAL (to second quarter, 2009), MEDLINE (1966 to May 2009), EMBASE (1980 to May 2009), CINAHL (1982 to May 2009), and PsycINFO (1806 to May 2009). Citation lists of review articles and included trials were examined. Selection criteria Any randomised controlled trials (RCTs) including spinal manipulative interventions (for example chiropractic, osteopathy, or manipulative physiotherapy) versus each other, placebo, no treatment, or another medical treatment were considered. Exclusion criteria were mild or infrequent dysmenorrhoea or dysmenorrhoea from an intrauterine device (IUD). Data collection and analysis Two trials of high velocity, low amplitude (HVLA) manipulation and one trial of the Toftness technique were included. Quality assessment and data extraction were performed independently by two review authors. No data were suitable for meta-analysis. Data were therefore reported as descriptive data. The outcome measures were pain relief or pain intensity and adverse effects. Main results Results from HVLA manipulation suggested that the technique was no more effective than sham manipulation for the treatment of dysmenorrhoea. One small trial indicated a difference in favour of HVLA manipulation however the one trial with an adequate sample size found no difference between HVLA and sham manipulation. There was no difference in adverse effects. The Toftness technique appeared more effective than sham treatment in one small trial but no conclusions could be made due to the size and other methodological limitations of the trial. Authors' conclusions There is no evidence to suggest that spinal manipulation is effective in the treatment of dysmenorrhoea. In the one trial reporting on adverse effects there was no greater risk of such events with spinal compared with sham manipulation.

Consultation with the Specialist: Dysmenorrhea

1. Paula J. Adams Hillard, MD* 1. *Professor, Department of Obstetrics & Gynecology and of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio After completing this article, readers should be able to: 1. Recognize the prevalence of dysmenorrhea in adolescents and its common results. 2. Describe a menstrual history that is most consistent with primary dysmenorrhea. 3. List the mediators of uterine pain and contractions believed to be involved in the pathophysiology of primary dysmenorrhea. 4. Recommend the appropriate evaluation and management of primary dysmenorrhea, including the appropriate choice and dosing of both over-the-counter and prescription medications. 5. Recognize patients who should be referred for evaluation of possible causes of secondary dysmenorrhea. A 15½-year-old girl came to the office with complaints of the recent onset of painful menstrual periods. She experienced her first menstrual period at the age of 13 years and except for an occasional mildly uncomfortable menstrual period, had not experienced significant pain until recently. She reported regular monthly menses, although she did not write down the dates. She described additional symptoms that also had not been present previously, including headache, loose stools, and breast tenderness. She has tried several over-the-counter medications, including acetaminophen, without significant relief. She has missed 3 days of school in the last 6 weeks because of these complaints. She is otherwise healthy, having no major illnesses, no history of surgeries, and no other genitourinary complaints. There is no family history of endometriosis; severe dysmenorrhea; menorrhagia; irregular periods; infertility; uterine fibroids; or breast, ovarian, colon, or uterine cancer. Her mother recalled that she had been prescribed oral contraceptives at the age of 16 years to alleviate her severe menstrual cramps. When spoken with privately, having been assured confidentiality, the girl denied sexual activity or abuse. She was doing well in school, making As and Bs, and felt that the relationship with her parents and one sister were good. She reported that she experienced crampy midline lower abdominal pain that began with the …

N-acetylcysteine attenuates kidney injury in rats subjected to renal ischaemia-reperfusion

The aim of the present study is to examine the effects of N-acetylcysteine (NAC), a thiol-containing anti-oxidant, on renal function and morphology, and biomarkers of oxidative stress, in rats subjected to renal ischaemia-reperfusion (IR). Sprague-Dawley rats underwent unilateral nephrectomy and either contralateral renal IR (40 min of renal arterial clamping), or sham manipulation. Treatment groups were: (1) IR-Saline, (2) IR-NAC, (3) Sham-Saline and (4) Sham-NAC. The N-acetylcysteine was administered in a dose of 200 mg/kg intraperitoneally at 24, 12 and 2 h before, and 24, 48 and 72 h after, renal IR. Plasma creatinine was measured on days 1, 3 and 7 after IR, and kidney histology was assessed on day 7. In separate groups of animals we measured renal levels of the anti-oxidant glutathione, markers of systemic oxidative stress (plasma ascorbyl radical, urinary 8-iso-prostaglandin F2alpha), and glomerular filtration rate (GFR) by 51Cr-EDTA clearance, on day 1 after renal IR. Treatment with NAC ameliorated the decline in GFR and reduced hyperkalaemia on day 1 (P<0.05), lowered plasma creatinine levels on days 1 and 3 (P<0.05), and decreased renal interstitial inflammation on day 7 (P<0.05), after renal IR. Kidney glutathione levels decreased significantly in group IR-Saline in response to IR (P<0.05), but were completely repleted in group IR-NAC. Groups with renal IR injury and acute renal failure showed increased plasma ascorbyl radical levels, and elevated urinary 8-iso-prostaglandin F2alpha excretion, compared with sham (P<0.05). N-acetylcysteine treatment reduced plasma ascorbyl concentrations 24 h after renal IR (P<0.05), but had no effect on the rate of urinary 8-iso-prostaglandin F2alpha excretion. N-acetylcysteine improves kidney function, and reduces renal interstitial inflammation, in rats subjected to renal IR. These effects were associated with increased renal glutathione levels, and decreased plasma ascorbyl concentrations, suggesting that NAC attenuates renal and systemic oxidative stress in this model.

Spinal Manipulative Therapy Reduces Inflammatory Cytokines but Not Substance P Production in Normal Subjects

To examine the effect of a single spinal manipulation therapy (SMT) on the in vitro production of inflammatory cytokines, tumor necrosis factor alpha, and interleukin (IL) 1beta, in relation to the systemic (in vivo) levels of neurotransmitter substance P (SP). Sixty-four asymptomatic subjects were assigned to SMT, sham manipulation, or venipuncture control group. SMT subjects received a single adjustment in the thoracic spine. Blood and serum samples were obtained from subjects before and then at 20 minutes and 2 hours after intervention. Whole-blood cultures were activated with lipopolysaccharide (LPS) for 24 hours. Cytokine production in culture supernatants and serum SP levels were assessed by specific immunoassays. Over the study period, a significant proportion (P </= .05) of sham and control subjects demonstrated progressive increases in the synthesis of tumor necrosis factor alpha and IL-1beta. Conversely, in a comparable proportion of cultures from SMT-derived subjects, the production of both cytokines decreased gradually. Normalization of the observed alterations to reflect the changes relative to self-baselines demonstrated that, within 2 hours after intervention, the production of both cytokines increased significantly (P < .001 to .05) in both controls. In contrast, a significant (P < .001 to .05) reduction of proinflammatory cytokine secretion was observed in cultures from SMT-receiving subjects. In all study groups, serum levels of SP remained unaltered within 2 hours after intervention. SMT-treated subjects show a time-dependent attenuation of LPS-induced production of the inflammatory cytokines unrelated to systemic levels of SP. This suggests SMT-related down-regulation of inflammatory-type responses via a central yet unknown mechanism.

Validation of a Sham Manipulative Procedure for the Cervical Spine for Use in Clinical Trials

To develop a sham manipulation procedure for the cervical spine for use in randomized clinical trials of cervical disorders. A single-group, single-intervention study design was used. Adult neck pain subjects underwent a screening examination that included palpation for a site of cervical spine joint dysfunction. Eligible subjects underwent measurements of regional cervical ranges of motion as well as pressure algometry (tenderness) at the site of cervical joint dysfunction. Subjects were instructed that they would receive one of several types of manipulative procedures. A newly developed sham manipulation was delivered once. Subjects were then remeasured for ranges of motion and tenderness. They were asked if they had experienced any pain during the procedure, if they had experienced a "cavitation" sound, and if they thought that the procedure they received was a "real" manipulation. Finally, they were debriefed as to the deception involved in this study. A prior level of 65% was set for endorsement that the procedure was a real manipulation. Changes in pre-post measures of ranges of motion and tenderness were analyzed descriptively for clinically important differences. Twenty eligible subjects were included (12 males, 8 females) with an average age of 30.4 (2.8) years. Twelve of the subjects were not students, with 3 of these having no prior experience with chiropractic treatment; 8 were students. Of the total sample (N = 19), 8 (42.1%) indicated that the procedure was a "real adjustment"; of the 12 nonstudents, 8 (58.3%) indicated similarly. None of the procedures in the final sample resulted in a cavitation, and none of the subjects registered the procedure as painful. None of the measures for ranges of motion or tenderness showed clinically important changes. The sham cervical manipulation studied here appears to approximate the necessary features of a placebo maneuver in that it is perceived by a majority of nonstudent neck pain subjects to be a real manipulation, although it does not produce any important change in cervical status. The small sample size of nonstudent participants precludes a strong recommendation for this procedure at this time.

Complementary and alternative therapies for low back pain

The support for the principles of evidence-based medicine has increased within the field of complementary and alternative medicine (CAM). The objective of this chapter is to determine the effectiveness of CAM therapies compared to placebo, no intervention, or other interventions for acute/subacute and chronic non-specific low back pain (LBP). Results from Cochrane reviews on acupuncture, botanical medicine, massage, neuroreflexotherapy, and spinal manipulation have been used. The results showed that acupuncture is more effective than no treatment or sham treatment for chronic LBP but that there are no differences in effectiveness compared with other conventional therapies. Specific botanical medicines can be effective for acute episodes of chronic non-specific LBP in terms of short-term improvement in pain and functional status; long-term efficacy was not assessed. Massage seems more beneficial than sham treatment for chronic non-specific LBP but effectiveness compared with other conventional therapies is inconclusive. Neuroreflexotherapy appears to be more effective than sham treatment or standard care for chronic non-specific LBP. Spinal manipulation was more effective than sham manipulation or ineffective therapies, and equally effective as other conventional therapies. In summary, the results on CAM therapies for (acute episodes of) chronic LBP are promising but more evidence on the relative cost-effectiveness compared to conventional treatments is needed.

A Randomized Trial Investigating a Chiropractic Manual Placebo: A Novel Design Using Standardized Forces in the Delivery of Active and Control Treatments

To evaluate the proposed manual placebo in terms of success in blinding patients to treatment group assignment and outcomes between the treatment groups. Randomized controlled trial. A chiropractic college research clinic in the midwestern United States. One hundred and eleven (111) individuals aged 18 years and over with subacute or chronic lowback pain. The active treatment consisted of flexion-distraction chiropractic manipulation and trigger point therapy and the control treatment of sham manipulation and effleurage; both groups received eight treatments over a 3-week period. The application of prescribed ranges of biomechanical forces for each treatment was standardized using specialized computerized equipment. "Nontreatment" aspects of the clinical encounter were to be standardized across groups. A primary clinician blinded to treatment assignment provided interpersonal interactions and treating clinicians delivered treatments with a minimum of interaction. The accuracy of the patient's perception of group assignment at visit 4 and the mean change in the Pain Disability Index (PDI) over the treatment period were the primary outcome variables. Patients in the control group were more likely to perceive their treatment assignment accurately than those in the active group (78% versus 54%, respectively). Patients in both treatment groups improved on the PDI and the Roland-Morris Questionnaire; there were no significant differences in improvement between the groups. Age, gender, prior chiropractic experience and expectation of treatment at baseline had no effect on outcomes. Patients in the control group were not successfully blinded; however, patients' perceptions of treatment group assignment did not significantly affect outcomes. The clinically significant improvement in both groups, independent of patient or clinician expectations, suggests the presence of therapeutic factors common to both groups, other than biomechanical force. Further studies examining other aspects of the clinical encounter, considered separately from biomechanical force, are warranted before arbitrarily designating any intervention as a "placebo."

Somatovisceral response following osteopathic HVLAT: a pilot study on the effect of unilateral lumbosacral high-velocity low-amplitude thrust technique on the cutaneous blood flow in the lower limb

Introduction Spinal manipulative treatment is widely used among manual therapists, although knowledge regarding the absolute physiological effects has not been clearly established. In this study, 20 healthy male subjects underwent a unilateral high-velocity low-amplitude thrust (HVLAT) to the lumbosacral junction, while the cutaneous blood flow in the corresponding dermatome of the lower limb was monitored. Methods Subjects underwent a sham manipulation before the actual manipulation and acted as their own control. Laser Doppler flowmetry was used to measure relative changes in the cutaneous blood flow over the L5 dermatome for 5 minutes before the sham manipulation, for 5 minutes between the sham and the actual manipulation, and for 5 minutes after the spinal adjustment. Analysis of variance (ANOVA) and Tukey post hoc analysis was used in the interpretation of the data. Results Twelve nonsmoking subjects, who received a successful HVLAT manipulation, showed a significant increase ( P < .001) in blood perfusion, both ipsilaterally and contralaterally. Six smokers responded with a significant decrease in blood flow ipsilaterally ( P < .01) and contralaterally ( P < .001) after HVLAT manipulation. Conclusion The results from this study support previous published hypotheses that spinal adjustments outside the region of the sympathetic outflow result in an increase in cutaneous blood flow. Further studies will be needed to confirm the outcome of this study, and more knowledge is needed regarding the specific neurophysiological effects of spinal manipulation.

ERNST RESPONDS TO HURWITZ ET AL.

Hurwitz, Meeker, and Smith raise further interesting points. Having published more than 50 systematic reviews, I am of course aware that such articles require a methods section. My article in the Journal was not, however, a systematic review, and nowhere do I pretend that it was. Hurwitz et al. say that another review contradicts my statement that there is no evidence to demonstrate that chiropractic spinal manipulation is more than a placebo.1 I disagree. The crucial discrepancy is that the article by van Tulder et al.1 was limited to back pain trials, while my systematic review2 was based on trials of spinal manipulation versus sham manipulation regardless of indication. Also, I don’t think that our result of 100% underreporting of serious complications3 is in any way contradicted by the suspicion emerging from another study4 that an approximately 50% incidence of mild and transient adverse effects could have been owing to overreporting. The obvious discrepancy here is that we are dealing with two dramatically different types of effect. These few lines clearly show that it is always possible to accuse people with whom one disagrees of using “deficient methods, a biased sample of reference material, selective reporting of results, and prejudicial language.” The readers might decide for themselves which side is more guilty of these “crimes” than the other. The more important point, however, seems to be missed: Many patients use chiropractic treatments, and even the most optimistic interpretation of the data must conclude that a risk–benefit evaluation is far less positive than most chiropractors make it out to be. In the interests of these many patients, it is urgent that we do the necessary research and clarify this important matter.

When to Use the Manipulation?

To the Editor: In “Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using A Combination of Tests: A Multicenter Intertester Reliability Study” (August 2002), Riddle et al seem to understand the original purpose of the 4 tests they examined, yet they go on to misinterpret and mischaracterize the utilization of these tests. In their abstract, the authors state that they have examined intertester reliability of measurements, but in the conclusion of the abstract they state that they “suspect it is likely that either the proper treatment technique will not be chosen based on the test results or the intervention will be applied to the wrong side.” The standing flexion, asymmetry of posterior superior iliac spines in sitting, long sitting, and prone knee bend tests were selected from a myriad of “sacroiliac joint [SIJ] signs” by Cibulka et al1 to operationally define SIJ dysfunction in order to conduct clinical trials. Indeed, the study by Cibulka et al, which Riddle et al state a purpose of their study was to replicate, contained 2 steps: the first to establish the reliability for the tests in question, and the second to obtain pretest-posttest measurements following manipulation or sham manipulation. A device combining a caliper, a protractor, and a plumb line was used to determine changes in sagittal-plane angles. At the University of Pittsburgh, we are pursuing a similar question with current technology. Researchers in 2 subsequent intervention studies2,3 also used these 4 criteria and the same manipulative technique. In these projects, it was necessary to operationally define “patients” as those who would benefit by extension exercises, because the existing guidelines were not adequate to assign patients to the category. The 4 SIJ tests were used to assign patients to the category where it was expected that the manipulation procedure …

Behavioral training increases local astrocytic metabolic activity but does not alter outcome of mild transient ischemia

Functional neurological outcome after transient ischemia might be improved by timely therapeutic intervention. To determine if restorative behavioral therapy influences damage, improves task learning, or alters astrocyte metabolic activity after ischemia, rats (food-restricted to 85% of free-feeding weight) were (a) first trained to respond on one of two levers under a fixed-ratio 20 schedule of food presentation (FR20), then (b) subjected to sham manipulation of carotid arteries or 10 min ischemia by four-vessel occlusion, followed by (c) 4 days of operant testing or inactivity, (d) then all rats were tested under a FR20 lever reversal task for 4 weeks, and (e) 3 days after the last behavioral session astrocyte metabolism was assayed by local uptake of [2- 14C]acetate. Mild loss of hippocampal neurons occurred in ischemic rats with or without training after ischemia. Glial fibrillary acidic protein-positive astrocytes were present in similar numbers throughout brains of sham control and ischemic rats. Mild ischemia did not impair learning, and no changes in FR20 reversal learning were detected in sham vs. ischemic rats. Net [ 14C]acetate uptake was unaffected by ischemia but [ 14C]acetate uptake increased 15–24% ( P<0.05; n=12–15/group) in specific structures (caudate, primary motor and sensorimotor cortex, CA1 hippocampus, subcortical white matter) in the pooled groups of rats that had 4 days FR20 testing vs. inactivity before reversal learning. ‘Behavioral therapy’ (operant testing on the 4 days immediately following either sham manipulation or ischemia) did not alter ischemic outcome, but was associated with higher acetate utilization in regions involved in motor activities.

Prey detection by vomeronasal chemoreception in a plethodontid salamander.

While chemoreception is involved in a wide variety of salamander behaviors, the chemosensory system that mediates specific behaviors is rarely known. We investigated the role of the vomeronasal system (VNS) in foraging behavior of the red-backed salamander (Plethodon cinereus) by manipulating salamanders' abilities to detect nonvolatile chemical cues emitted by potential prey. Subjects received one of three treatments: (1) impaired vomeronasal system, (2) sham manipulation, and (3) no manipulation. The role of the VNS in mediating foraging on motile prey (Drosophila melanogaster) was investigated under three light conditions (bright, dim, dark). Salamanders with impaired VNSs foraged less efficiently than either of the other experimental groups by displaying the longest latency to attack and the lowest rate of prey capture, especially in the absence of visual cues. A second experiment utilized freshly killed prey to determine whether the VNS takes on added importance in the absence of visual or tactile cues associated with moving prey. Animals with impaired VNSs showed a decreased foraging efficiency on stationary prey under both dark and light conditions. In addition, a mark-recapture study of VNS-impaired and sham salamanders in the field also indicated that salamanders with impaired VNSs consumed fewer stationary prey compared to shams. The study indicates that the VNS plays a substantial role in the foraging behavior of the plethodontid salamander, P. cinereus.

Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil)

Background: It has generally been assumed that spinal manipulation has the biomechanical effect of increasing spinal range of motion. Past research has shown that there are likely no lasting changes to passive range of motion, and it is unclear whether there is an increase in active range of motion after manipulation. Objective: To study changes in active cervical range of motion after spinal manipulation of the cervical spine. Design: A double-blind randomized controlled trial at the outpatient clinic Phillip Chiropractic Research Centre, RMIT University, Melbourne, Australia. Methods: One hundred five patients with cervicogenic headache were randomized into 2 groups. After a baseline observation period, Group 2 received manipulation (toggle recoil) to the cervical spine, whereas Group 1 received sham manipulation. In the next trial phase, Group 1 received manipulation, whereas Group 2 received no treatment. This was followed by the final trial phase, in which Group 2 received sham manipulation and Group 1 received no treatment. After each trial phase, active range of cervical motion was measured with a strap-on head goniometer by 2 blinded examiners. Results: After receiving spinal manipulation, active range of motion in the cervical spine increased significantly (P < .0006) in Group 2 compared with Group 1, and this difference between the treatment groups disappeared after the third trial phase in which Group 1 also received manipulation, as expected. Conclusion: Spinal manipulation of the cervical spine increases active range of motion. (J Manipulative Physiol Ther 2001;24:552-5)